- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,819.70 / $2,511.89
| Facility | | $186.21 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $173.78 / $234.42
| Professional | | $147.91 | $173.78 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $269.15 / $338.84
| Professional | | $181.97 | $269.15 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,071.52 / $2,570.40
| Facility | | $371.54 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $199.53 / $331.13
| Professional | | $144.54 | $199.53 | $331.13 |